Older Population and Health System: A profile of Thailand I. Introduction to Thailand The Kingdom of Thailand was established in the mid-14th Century, known as Siam until 1939. A revolution in 1932 led to a constitutional monarchy. It lies in the heart of Southeast Asia. The country shares a long border with Myanmar to the west and the north, Lao P.D.R. to the north and the northeast, Cambodia to the east and Malaysia to the south. Thailand is divided into four distinct geographical regions: the mountainous North, the fertile Central Plains, the semi-arid plateau of the Northeast and the peninsula South At present, there are around 62.3 million people, of which 32% live in urban areas. Although most of Thailand is agricultural, the social and economic developments have changed the economy rapidly to industrialized productions and service sectors. After enjoying the world’s highest growth rate from 1985 to 1995 – averagely almost 9% annually – increased speculative pressure on Thailand currency in 1997 led to a crisis that uncovered financial sector weakness and forced the government to float the value of the Baht. Thailand entered a economic recovery stage in 1999. Nevertheless, the economic ordeal has a significant impact on country’s labor structure, population migration, urbanization and life styles. The Gross Domestic Product (GDP) per Capita is $7,248 in 2002. GDP- composition by sector is 11% in agriculture sector, 40% in industry and 49% in services. Average consumer price index (CPI) in 2001 is only 1.6%. The CPI in food and non-food are 0.4% and 2.2% respectively. More than 50% of the total population (32.17 million) is in the labor force, of which 42% in agriculture and the rest 58% in non-agricultural sector. The unemployment rate is 5.16% in 2001. Currently, Thailand is experiencing among the most rapid rates of population ageing in the developing world. The demographic shift from younger to older population age structure in Thailand is a recent phenomenon. The rapidity of the current change in Thailand stands in contrast to historical developments in most Western countries. This implies that the country will face emergent issues related to social security, health care costs and intergenerational equity and so on in a far shorter time span than that happened in the West. These issues require appropriate policies and programmes development to deal with. Hence, it is imperative that Thailand has a well prepared National Policy and Programme on ageing as well as for long-term care services for older persons. II. Population ageing in Thailand 1. Demographic Trends of Population Ageing During the past several decades, Thailand has been one of the most successful countries in bringing down its fertility level within a short period of time. The total fertility rate has declined from over 6 births per woman in the mid 1960s to below 2 in the mid-1990s (Table 1). During the same period, life expectancy at birth increased from 55.2 years to 69.9 years for men and 61.8 years to 74.9 years for women. In the coming decades, besides the lowering of the growth rate, a major demographic consequence of this rapid fertility reduction will be an inevitable ageing of the population. Even more dramatic will be the rapid increase in the absolute size of the older population (aged 60 and over), a result of past high fertility levels and substantial declines of mortality. 19 A demographic transition can be indicated by age profiles or “Population Pyramid”. Figure 1 shows actual age profiles of the population of Thailand in 1960 and 1980, and projected profiles in 2000 and 2020. These four age profiles depict changes in population structure from a pyramid in 1960 towards a bell shape in 2000 and a vast shape in 2020. Table 1 Life expectancy at birth and total fertility rate, 1960-2025. Year Men-E0 Women-E0 TFR 1960-65 51.9 56.2 6.39 1970-75 57.7 61.6 4.99 1980-85 62.9 67.6 2.96 1990-95 65.4 71.8 1.94 2000-05 66.3 72.7 1.74 2010-15 69.9 75.7 1.85 2020-25 72.6 78.1 1.90 Source: United Nations, 1999a Figure 1 Age profile of the population of Thailand in 1960, 1980, 2000 and 2020. 196 1980 0 200 2020 0 Source: Jitapunkul, S. and Bunnag, S., 1998 Table 2 presents the past trends and future projections of key demographic indicators related to population ageing in Thailand for the period 1980-2050 as estimated by the United Nations (United Nations, 1999a). Three main characters of the ageing population in Thailand are noted, namely a considerable change in the age structure of the population, a rapid increase 20 in the share of the older population, and an increase in the proportion female in the older age groups. Trends in the growth rates and the sheer size of the older population are also remarkable. The older population is growing faster than the growth of the total population. The rapid increase in the proportion of the older population implies a sharp increase in the size of the elderly population. Thailand’s total population grew by 31 percent between 1980 and 2000, increasing from 46.7 million to just over 60 million at present. At the same time the population growth declined substantially, from 3 percent around 1970 to under 1 percent currently (Table 2A and 2B). Table 2A Projected trends in selected demographic measures of the older population in Thailand, 1980-2050. 1980 1990 2000 2010 2020 2050 1) Population (in 1,000) Total 46,718 55,595 61,399 66,511 70,975 74,188 60+ 2,527 3,716 5,338 7,205 10,765 21,981 65+ 1,649 2,408 3,576 4,953 7,168 17,076 75+ 484 798 1,192 1,852 2,594 8,222 85+ - - 198 327 540 1,946 2) % Increase over 1980 Total - 19.0 31.4 42.4 51.9 58.8 60+ - 47.1 111.2 185.1 326.0 769.8 65+ - 46.0 116.9 200.4 334.7 935.5 75+ - 64.9 146.3 282.6 436.0 1,598.8 3) Population growth rate Total 1.7 1.0 0.8 0.6 -0.1* 60+ 3.9 3.6 3.0 4.0 0.9* 4) % of total population aged: < 15 40.0 31.9 25.2 21.6 19.8 16.8 60+ 5.4 6.7 8.7 10.8 15.2 29.6 65+ 3.5 4.3 5.8 7.4 10.1 23.0 5) % of the total older population aged: 70+ 38.3 39.6 41.3 45.1 41.3 57.3 75+ 19.2 21.5 22.3 25.7 24.1 37.4 85+ - - 3.7 4.5 5.0 8.9 6) % Female 60 + 54.7 54.8 55.5 55.8 55.6 54.9 75 + 58.5 59.9 60.0 60.7 60.6 59.0 85 + - - 65.2 65.4 65.4 63.7 7) Dependency ratio Total 83.2 62.9 51.3 47.9 53.8 86.5 <15 73.3 52.0 38.1 31.9 30.5 33.2 60+ 9.9 10.9 13.2 16.0 23.3 55.3 Source: Calculated from data provided in the United Nations, 1999b (* is the average rate during 2040-2050.) 21 Table 2B Projected trends in selected demographic measures of the population aged 50+ years in Thailand, 1980-2050. Total Age 50+ 60+ 65+ 50-59 60-69 70+ 19801 11.3 5.5 3.5 5.9 3.3 2.1 50+ 60+ 65+ 50-59 60-69 70-79 80+ 19902 15.0 7.4 4.7 7.7 4.5 2.1 0.8 20003 18.0 9.4 6.1 8.6 5.8 2.7 0.9 20104 21.4 10.8 7.4 10.6 5.9 3.5 1.3 20204 28.8 15.2 10.1 13.7 8.9 4.4 1.9 20254 32.6 18.1 12.3 14.5 10.4 5.5 2.2 20504 41.4 29.6 23.0 11.8 12.7 10.8 6.2 Males Year Age 50+ 60+ 65+ 50-59 60-69 70+ 19801 10.8 5.0 3.2 5.8 3.2 1.8 50+ 60+ 65+ 50-59 60-69 70-79 80+ 19902 14.4 6.9 4.2 7.5 4.4 1.9 0.6 20003 17.2 8.7 5.6 8.4 5.5 2.5 0.7 20104 19.9 9.7 6.4 10.3 5.6 3.0 1.0 20204 27.2 13.6 8.8 13.6 8.4 0.1 1.4 20254 30.9 16.4 10.8 14.5 9.9 4.8 1.6 20504 39.3 27.3 20.7 12.0 12.5 9.9 4.9 Females Age 50+ 60+ 65+ 50-59 60-69 70+ 19801 11.9 5.9 3.9 5.9 3.4 2.5 50+ 60+ 65+ 50-59 60-69 70-79 80+ 19902 15.7 7.9 5.1 7.8 4.6 2.3 1.0 20003 18.8 10.1 6.7 8.7 6.1 2.9 1.1 20104 22.9 12.0 8.5 10.9 6.3 4.0 1.7 20204 30.4 16.7 11.4 13.8 9.4 0.3 2.4 20254 34.2 19.7 13.7 14.5 10.9 6.1 2.7 20504 43.5 31.9 25.2 11.6 12.8 11.6 7.4 Source: National Statistical Office, 1984, 1994, 2001 Calculated from data provided in the United Nations, 1999b The proportion of the population in their elderly years (60+) is anticipated to increase from 8.7 percent in 2000 to 10.8 percent in the year 2010, 15.2 percent in the year 2020, and 30 22 percent in the year 2050.